clarity presentation 2020 - wespeakmedicare.org · name: 2020 community meeting presentation stage:...

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4Internal & External TeamDate: 4-9-2020 1:20 PMCreative Prod. Mgr: Rachel HollifieldJob Number: UMR202000032_09

Project DetailsDepot #: SPRJ54760 JPC Score: Name: 2020 Community Meeting PresentationStage: FINAL Reading Level: 5.7File Name: SPRJ54760_FINAL

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ClarityPresentation2020

Get more for your Medicare dollar. Take advantage of it.

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Welcome

This presentation contains information that UnitedHealthcare® wants to make sure you understand.

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You’re eligible for Original Medicare (Parts A and B) if:You’re at least 65 years old, or you’re under 65 and qualify on the basis of a disability or other special situation.

AND

You’re a U.S. citizen or a legal resident who has lived in the U.S. for at least 5 consecutive years.

Medicare eligibility.

Medicare Made Clear®

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When can you enroll in a Medicare Advantage or prescription drug plan?

Initial Enrollment PeriodYour Initial Enrollment Period (IEP) is 7 months long. It includes your 65th birthday month plus the 3 months before and the 3 months after. It begins and ends 1 month earlier if your birthday is on the first of the month. You may enroll in Part A, Part B or both. You may also choose to join a Medicare Advantage plan (Part C) or a prescription drug plan (Part D). Prescription drug coverage must be creditable or you may be subject to a late‑enrollment penalty when you enroll in a plan with Part D benefits.


Sept. Oct. Nov. Dec. Jan. Feb. Mar. Apr. May June July Aug.

Special Enrollment PeriodAnnual Enrollment October 15 – December 7

Medicare Advantage Open Enrollment Period January 1 – March 31

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Annual Enrollment Period, October 15 – December 7During annual enrollment you can add, drop or switch your Medicare coverage.






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Medicare Advantage Open Enrollment Period, January 1 – March 31If you are already a Medicare Advantage plan member, you may disenroll from your current plan and switch to a different Medicare Advantage plan one time only during this period.

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Special Enrollment PeriodDepending on certain circumstances, you may be able to enroll in a Medicare plan outside of the initial enrollment or annual enrollment time frames. Some ways you may qualify for a Special Enrollment Period, are you:

• Retire and lose your employer coverage • Move out of the plan’s service area • Receive assistance from the state • Have been diagnosed with certain qualifying disabilities or chronic health conditions • Qualify for Extra Help

Special Needs Plans have other eligibility requirements.

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Medicare choices.After you enroll in Original Medicare (Parts A and B), there are two ways to get additional coverage.

Enroll in Original Medicare.STEP

1


Original MedicareProvided by the federal government

Helps pay for hospital stays and inpatient care

Helps pay for doctor visits and outpatient care

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Decide if you need additional coverage. You have two ways to get it.STEP

2


Choose a Medicare Advantage plan:Add one or both of the following to Original Medicare:

OPTION 1 OPTION 2OR

Medicare Advantage PlanOffered by private companies

Combines Part A (hospital insurance) and Part B (medical insurance) in one plan

Usually includes prescription drug coverage

May offer additional benefits not provided by Original Medicare

Medicare Supplement Insurance (Medigap)Offered by private companies

Helps pay some of the out‑of‑pocket costs that come with Original Medicare

Medicare Part D PlanOffered by private companies

Helps pay for prescription drugs

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Compare the coverage.Look at the coverage you could be getting from a Medicare Advantage plan.

Benefits and Features Medicare Advantage*

Medicare Supplement (Medigap)*

Original Medicare

Helps pay for hospital stays

Helps pay for some medical care, like doctor visits

Helps pay for preventive services, like flu shots

Helps pay for prescription drugs No coverage** No coverage

Routine vision coverage Varies by plan No coverage

Routine hearing exam and hearing aid coverage Varies by plan No coverage

Limits your annual out‑of‑pocket costs No protection

*Benefits vary by plan.**Requires purchase of a stand‑alone prescription drug plan.

Get More With Medicare Advantage

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Medicare Advantage plans typically include:


Prescription drug coverage

Worldwide emergency care

Annual physical and screenings

Out-of-pocket spending limits

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Medicare Advantage plans have high member satisfaction:


22.6million people are enrolled

in a Medicare Advantage plan as of March 1, 20191

91%of seniors are satisfied

with their Medicare Advantage plan2

87%of seniors are satisfied with preventive care they

received from their Medicare Advantage plan2

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Medicare Advantage versus Original Medicare:


31%fewer hospitalizations3

19%shorter average length

of a hospital stay4

25%less spent on health care5

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Medicare AdvantageMedicare Advantage eligibility checklist.

Enrolled in Original Medicare (Part A and Part B)

Live in the plan’s service area

Do not have end‑stage renal disease (ESRD) — some exceptions may apply

AND

AND

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Medicare AdvantageAre there Medicare Advantage plans for those with special needs?

Yes. There are special types of Medicare Advantage plans called Special Needs Plans. These plans include focused and specialized health care coverage for specific groups:

• Dual-eligible plans for those with both Medicare and Medicaid • Chronic condition plans for those with certain ongoing medical conditions such as diabetes or a cardiovascular disorder • Institutional plans for those living in a nursing home

Talk to a sales representative or visit UHCClarity.com if you would like more information regarding Special Needs Plans.

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10 important things to know about Medicare Advantage.

1 You must continue to pay your Medicare Part B premium.Medicare then gives your premium to your UnitedHealthcare Medicare Advantage plan to help pay for your additional coverage.

2 Joining a Medicare Advantage plan may affect your current coverage.If you have existing coverage or employer‑provided health insurance and plan to work past 65, check to see how joining a Medicare Advantage plan could affect or cancel your current coverage.

3 It’s best to use network providers.Use of network health care and pharmacy providers is typically required. Using providers outside of the network may cost you more. In an emergency, you can use any provider.

4 You may qualify for financial assistance.Depending on your financial situation, you may qualify for help paying your plan premiums or Part D medications through a low income subsidy or Extra Help.

5 If you enroll in Part D late, you may pay a penalty. This is an additional amount charged by Medicare that will be added to your Part D premium if you go without Part D coverage for longer than 63 days in a row after your Initial Enrollment Period. Medicare Advantage plans that include Part D coverage meet Medicare coverage requirements.

Medicare Advantage

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Medicare Advantage10 important things to know about Medicare Advantage.

6 A Medicare supplement insurance plan (Medigap policy) is not a Medicare Advantage plan.Medicare supplement plans are health insurance policies and are secondary to Original Medicare. Medicare Advantage plans combine Original Medicare Parts A and B, and sometimes Part D, into a single plan.

7 Keep your member ID card handy.Members must present their UnitedHealthcare member ID card, not their Original Medicare card, when receiving services.

8 Medicare Advantage offers the same protections as Original Medicare. Even though Medicare Advantage plans are privately administered, you still have the same rights and protections as with Original Medicare.

9 Medicare Advantage has you covered.Medicare Advantage plans must cover all the services that Original Medicare covers and may offer additional benefits. Important: Hospice care is still covered under Original Medicare. You may also receive more benefits if you have TRICARE for Life or VA coverage.

10 You have a built-in financial safety net.Your plan’s annual out‑of‑pocket maximum is your safety net that ensures you’ll never pay more than a certain amount out of pocket in a given plan year for covered medical services.

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Understanding Medicare drug payment stages.

Annual Deductible Initial Coverage Coverage Gap* (Donut Hole)

Catastrophic Coverage

In this drug payment stage:

In this drug payment stage:

After your total drug costs reach $4,020:

After your total out-of-pocket costs reach $6,350:

•You pay for your drugs until you reach the deductible amount set by your plan. •Not all Part D plans have a deductible.* • If your plan does not have a deductible, your coverage starts with the first prescription you fill.

•You pay a copay or coinsurance and the plan pays the rest. •You stay in this stage until your total drug costs reach $4,020 in 2020.

• In 2020, you pay:– 25% of the costs for

brand name drugs– 25% of the costs for

generic drugs •You stay in this stage until your total out-of-pocket costs reach $6,350 in 2020.

•You pay a small copay or coinsurance amount. •You stay in this stage for the rest of the plan year.

Prescription Drug Coverage

* If you get Extra Help from Medicare on your Part D costs, the Part D deductible and coverage gap do not apply to you.

Total drug costs:The amount you pay (or others pay on your behalf) and the plan pays for prescription drugs starting January 2020. This does not include premiums.

Out-of-pocket costs:The amount you pay (or others pay on your behalf), including the deductible, for prescription drugs starting January 2020. The out‑of‑pocket costs also include the discount paid by the drug manufacturers while in the donut hole. This does not include premiums.

Note: On January 1 of each plan year, the coverage cycle starts over and the dollar limits can change. Amounts listed above reflect the 2020 plan year.

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Pharmacy networkUnitedHealthcare has more than 65,000 network pharmacies across the country. To receive benefits, you must use an in‑network pharmacy and show your UnitedHealthcare member ID card. You may receive additional discounts on your prescriptions by using a preferred retail pharmacy or by using the mail service pharmacy and having your medications delivered to your mailbox.

Drug list (formulary)A formulary is a list of the drugs that a plan covers. Each plan has its own drug list.

Tiered formularyMany plans use tiered formularies to group covered drugs according to cost. For example:

• Tier 1 – Preferred generic drugs • Tier 2 – Generic drugs • Tier 3 – Preferred brand name drugs • Tier 4 – Non‑preferred drugs • Tier 5 – Specialty drugs

Prescription drug coverage defined.


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Step therapyOne way UnitedHealthcare can help you save money on your prescriptions is by offering lower‑cost drugs that can treat the same medical condition as your current brand name drugs. You may be asked to try one or more of these lower‑cost drugs before the plan will cover the brand name drug you are currently taking.

Quantity limitsSome drugs have quantity limits, where the plan will cover only a certain amount of a drug for one copay or over a certain number of days. The limits may be in place to ensure safe and effective use of the drug. If your doctor prescribes more or thinks the limit is not right for your situation, you and your doctor can ask the plan to cover the additional quantity.

Prior authorizationBefore the plan will cover certain drugs, it may need more information from your doctor to make sure the drug is being used correctly for a medical condition covered by Medicare. You may be required to try a different drug before the plan will cover the prescribed drug.

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Asking for an exceptionIf you need a drug that’s not currently covered by your plan, you may:

Ask the plan to cover your drug even if it is not on the drug list. This is known as a formulary exception.

Ask to waive coverage restrictions or limits on your drug. This is known as a utilization exception.

Coverage decisionsIf your doctor has submitted an exception request on your behalf, generally the plan will make a decision within 72 hours. You can request an expedited, or fast, decision if you or your doctor believes your health requires it.


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Get more for your Medicare dollar.Take advantage of it.More choice and more helpful guidance.Everyone’s health needs are diff erent, which is why UnitedHealthcare off ers a broad range of Medicare Advantage plans. And whether you’re new to Medicare or are looking to change coverage, our knowledgeable advisors and agents will guide you through choosing the plan that’s right for you — in person, online or over the phone.

A health care company you can rely on.More people choose UnitedHealthcare for their Medicare coverage than any other company.6 And we’ve been serving the health care needs of people just like you for more than 40 years.

The only Medicare plans that carry the AARP name.UnitedHealthcare has an exclusive relationship with AARP to off er Medicare plans with the AARP name.

Compassionate care.Our compassionate member advocates are here to help you get more from your plan — by answering questions, scheduling appointments and connecting you to programs to help you manage your health.

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Take an active role in your health with Renew.Renew by UnitedHealthcare* helps you unlock your unique potential and live your best life — with access to a wide range of resources, such as Renew magazine, brain games, recipes, learning courses, fi tness activities, videos and more. Plus, you may be eligible to earn gift card rewards by completing certain health care activities such as your annual physical or wellness visit, preventive screenings or a fl u shot.**

* Renew by UnitedHealthcare is not available in all plans. Resources may vary.** Reward off erings will vary by member and Renew Rewards is not available in all plans

with Renew by UnitedHealthcare.

Articles

Healthy RecipesEducation

BrainGames

Get more for your Medicare dollar.

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Renew can help you take a more active role in your health and wellness through:

Get more for your Medicare dollar.

Renew magazine Interactive quizzes and tools

Rewards Health news, articles and videos

Brain games Health topic library

Recipe library Photo gallery

Learning courses Streaming music

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Using your Medicare Advantage Enrollment Guide.

A plan’s Enrollment Guide is designed to put useful information about Medicare Advantage plans at your fingertips. This information includes:

Benefit Highlights An overview of the plan’s most common benefits.

Summary of Benefits A summary of the health and drug services the plan covers.

Drug List A list of drugs and their tier level covered under the plan.

Ready to Enroll Everything you need to enroll, including enrollment forms and a Plan Recap.

Plan Information Helpful information about how your plan works, including additional programs and services it offers beyond what Original Medicare covers.

Required Information Instructions for accessing free language interpreter services available to answer questions you may have about a plan at no additional cost.

Decision-Making Tools

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Star Ratings Medicare uses a 5‑star rating system to measure how well plan sponsors perform in different categories. These ratings help consumers and members compare plans based on quality and performance. CMS utilizes 1 to 5 stars to determine a plan’s performance in a particular category. A 1‑star rating denotes poor quality and a 5‑star rating represents excellent quality. Additional information can be found at Medicare.gov.

Decision-Making ToolsUsing your Medicare Advantage Enrollment Guide.

A plan’s Enrollment Guide is designed to put useful information about Medicare Advantage plans at your fingertips. This information includes:

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In addition to your sales representative, there are other useful resources available to you.

• Medicare Made Clear• Medicare• Social Security• Administration on Aging• AARP• State Resources

For a full list of resources and contact information, see page 13 in your Clarity Workbook.

Decision-Making Tools

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If you have questions, or know someone who might be interested in enrolling in a UnitedHealthcare plan, please contact me:

Are you ready to enroll?

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Dan RedlerLicensed Sales Representative425-462-9409, TTY 711UHCMedicareSolutions.com

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1 State_County_Penetration_MA_2019_03.csv,” in “MA State/County Penetration – March 2019 ZIP file,” https://www.cms.gov/Research‑Statistics‑Data‑and‑Systems/Statistics‑Trends‑and‑Reports/MCRAdvPartDEnrolData/MA‑State‑County‑Penetration‑Items/MA‑State‑County‑Penetration‑2019‑03.html?DLPage=1&DLEntries=10&DLSor =1&DLSortDir=descending, 3/2019

2 http://bma.devbox12.com/sites/default/files/Mellman‑Winston‑Joint‑Summary‑of‑Recent‑Medicare‑Advantage‑Survey‑2015_0.pdf, Poll, The Winston Group; The Mellman Group, 600 Sr., 2/24‑28/2015

3 Stephen Patterson, Andrew Bazemore, Yalda Jabbarpour and Peter Wingrove, “Understanding The Impact Of Medicare Advantage On Hospitalization Rates,” http://www.graham‑center.org/content/dam/rgc/documents/publications‑reports/reports/BMA_Report_2016.pdf, 3/15/16

4 Jon Kaplan, Jan Willem Kuenen, Mike Pykosz and Stefan Larsson, “Alternative Payer Models Show Improved Health‑Care Value,” https://www.bcgperspectives.com/content/articles/health_care_payers_providers_alternative_payer_models_show_improved_health_care_value/?chapter=3, 5/14/13

5 Vilsa Curto, Liran Einav, Amy Finkelstein, Jonathan D Levin, and Jay Bhattacharya, “Healthcare Spending and Utilization in Public and Private Medicare,” https://www.nber.org/papers/w23090.pdf, 1/2017

6July 2019 CMS and Internal Company Enrollment Data7In Hawaii, 8 a.m. – 8 p.m., Monday – Friday; 8 a.m. – 5 p.m., SaturdayMember may use any pharmacy in the network but may not receive preferred retail pharmacy pricing. Pharmacies in the Preferred Retail Pharmacy Network may not be available in all areas. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. You do not need to be an AARP member to enroll. AARP encourages you to consider your needs when selecting products and does not make specific product recommendations for individuals. AARP does not employ or endorse agents, producers or brokers.©2020 United HealthCare Services, Inc. All rights reserved.

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Go ahead, take advantage.

From the UnitedHealthcare® family of Medicare plans.

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